| NPI | 1174952253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A10110) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: NC A10110) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |